February 13, 2014

Two physicians highlight why medical science makes it important to re-schedule marijuana

Orrin Devinsky and Daniel Friedman, two physicians at the NYU Comprehensive Epilepsy Center, provide an informative and sober discussion of medical marijuana issues and research problems in this New York Times op-ed headlined "We Need Proof on Marijuana." Here are excerpts:

Many people have heard the story of Charlotte Figi, a young girl from Colorado with severe epilepsy. After her parents began giving her a marijuana strain rich in cannabidiol (CBD), the major nonpsychoactive ingredient in marijuana, Charlotte reportedly went from having hundreds of seizures per week to only two or three per month. Previously, her illness, Dravet Syndrome, was a daily torture despite multiple high doses of powerful anti-seizure drugs.

As news of Charlotte’s story moved from the Internet to a CNN story by Dr. Sanjay Gupta to Facebook pages, some families of children with similar disorders moved to Colorado, which recently legalized marijuana, to reap what they believe are the benefits of the drug.

Dozens of other anecdotes of miraculous responses to marijuana treatments in children with severe epilepsy are rife on Facebook and other social media, and these reports have aroused outsize hopes and urgent demands. Based on such reports, patients and parents are finding official and backdoor ways to give marijuana to their children.

But scientific studies have yet to bear out the hopes of these desperate families. The truth is we lack evidence not only for the efficacy of marijuana, but also for its safety. This concern is especially relevant in children, for whom there is good evidence that marijuana use can increase the risk of serious psychiatric disorders and long-term cognitive problems.

The recent wave of state legislatures considering and often approvingmedical marijuana raises significant concerns. By allowing marijuana therapy for patients with diseases such as difficult-to-control epilepsy, are state legislatures endorsing the medical benefits and safety of a broad range of marijuana species and strains before they have been carefully tested and vetted? Marijuana contains around 80 cannabinoids (THC is the major psychoactive cannabinoid, largely responsible for the high) and more than 400 other compounds. The chemical composition of two genetically identical plants can vary based on growing conditions, soil content, parasites and many other factors.

While the language of the legislation may be cautious, there is an implied endorsement of medical benefit for marijuana when a legislature passes a bill and a governor signs it into law, and the tremendous gaps in our knowledge are not effectively conveyed to the public....

Before more children are exposed to potential risks, before more desperate families uproot themselves and spend their life savings on unproven miracle marijuana cures, we need objective data from randomized placebo-controlled trials....

Paradoxically, however, as state governments increasingly make “medical” marijuana available to parents to give to their children, the federal government continues to label the nonpsychoactive CBD — as well as THC — as Schedule 1 drugs. Such drugs are said to have “no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.” This designation hamstrings doctors from performing controlled studies. While it is possible to study Schedule 1 drugs in a controlled laboratory setting, it is extremely difficult to study these substances in patients. For our study, we keep the CBD in a 1,200-pound safe in a locked room, in a building with an alarm system.

To foster research, we need to change compounds derived from marijuana from Schedule 1 to a less restrictive category. It is troubling that while few barriers exist for parents to give their children marijuana in Colorado, there are significant federal roadblocks preventing doctors from studying it in a rigorous scientific manner.

When patients have not been able to get successful medical treatment, and they live in a state where the law allows medical marijuana for children — we are not suggesting they smoke the drug — compassionate use is reasonable. But for the long-term health of Charlotte and other patients like her, we urgently need valid data.

Comments

The good doctors write: "To foster research, we need to change compounds derived from marijuana from Schedule 1 to a less restrictive category. It is troubling that while few barriers exist for parents to give their children marijuana in Colorado, there are significant federal roadblocks preventing doctors from studying it in a rigorous scientific manner."

I say, NO! This proposal is much too reasonable. Think of the slippery slope: admitting that marijuana might actually have some beneficial use and removing it from Schedule I will inevitably lead to the legalization of heroin, won't it? I think it better that, like the ostrich, we keep our heads in the holes in the ground.

Posted by: observer | Feb 13, 2014 12:31:05 PM

Well said, Observer.

Bill Otis and his knuckle-dragging, oops, I mean esteemed, brethren have been right all along, haven't they? What do these silly NYU physicians know? They must just be druggies, huh? Bill, et al., know much better than these doctors about the evils of marijuana. Just ask them. And that little girl -- she should just suck it up and take the hourly or daily seizures. Marijuana must be stomped out. It's really, really evil. Bill knows it all. He's just swell.

Posted by: David Jenkins | Feb 13, 2014 1:56:42 PM

David Jenkins --

Take it up with the AMA, if you're ever off the bong long enough to write a letter.

This is quite the strawman. Cocaine and opiates are both schedule 2 substances. The former is frequently used during nose and throat surgery, the latter for pain management. I don't think any serious person is worried about legalization of everything of marijuana is moved to schedule 2. Rather, I think that people are worried (valid or not) about legalization of MARIJUANA if it becomes a schedule 2 substance.

Given the vast overstatements of its medicinal benefits, I'm not entirely convinced that its designation as a schedule 1 substance is unjustified if you are against full legalization.

From my standpoint, I simply disagree with the premise that pot should be illegal--not because I think it's a good think for people to light up (I concede we will probably see an increase in certain social ills as a result), but because I don't think the other costs (societal and economic) to keeping it illegal is worth the benefit. Same reason why I don't think we should ban cigarettes or high fructose corn syrup...even though both are literally poison.

If your bleeding knuckles are hurting, I hear that smoking a doobie might help. Just make sure there's a Taco Bell within walking distance.

Posted by: Res ipsa | Feb 13, 2014 3:07:43 PM

Res ipsa --

Fear not. As my fitness trainer can grumpily attest, I'm well acquainted with the location of the Taco Bell.

Posted by: Bill Otis | Feb 13, 2014 3:33:13 PM

What about it Billy? Should that little girl just suck it up and endure countless seizures, as D. Jenkins sarcastically suggested? Why? To allay your phantom fears of reefer madness?

Your constant refrain about the views of the AMA is typical of the stuff you utter on this blog: empty blather. Who comprises the AMA? Is the healthcare of patients a priority of the AMA? You might want to read this. <> But, you probably won't. You're not concerned about what is actually right on this issue.

Posted by: Scarlett Rose | Feb 13, 2014 4:08:11 PM

"Your constant refrain about the views of the AMA is typical of the stuff you utter on this blog: empty blather."

I want to assure the board that I did NOT pay Scarlett Rose to say that posting the views of the American Medical Association about the value vel non of pot as "medicine" is an example of my "empty blather."

It is truly, wonderfully, magnificently revealing that the pro-pot crowd -- after years of bellowing that marijuana should be treated as a medical, not a criminal, issue -- now condemns as "empty blather" the considered views of the AMA.

As I say, I didn't pay Ms. Scarlett to write her comment -- but I would have. Some things are so revealing that they're worth good money.

Posted by: Bill Otis | Feb 13, 2014 5:39:19 PM

The AMA is not a research organization. It is essentially a trade union and always has been. Most of it's positions are politically based. The AMA supported the ACA. It does not represent a a very large per cent of physicians in the US and the % is declining.

It would be interesting to know the composition of the remaining members - they may be from specialities that benefit most by compulsary mental health treatment. This would explain their stance - Perhaps that's a project for me.

ABA is to lawyers as AMA is to doctors, a joke. It is a left wing Chicago based, Ivy indoctrinated dumbass dominated Obama collaborator, traitors to clinical care. Roe v Wade plagiarized an AMA resolution, resulting in a lawless American holocaust. Unforgivable slaughter of innocents by endorsed by doctor language. Zero credibility. Heinous. Traitors. Vermin. Quote the AMA to most doctors, you have just lost all opportunity to persuade.

I have spent time debunking the current methodologies of the legal profession. The methods of the medical profession are as problematic, and their mistakes kill. The data being demanded is nearly worthless. Without diverging into a separate subject, here is a brief, and incomplete summary. Matters are worse than stated in here.

Say a drug harms 90% of patients, they do worse than the placebo control. Say, it should be banned as a poison. However, it stops intractable seizures in a single patient. For that patient, it is safe and effective. One may do an experiment on this patient, on off, on off, count the seizures. Do it twice, it cannot be coincidence, and is scientifically proven effective in that one patient. No matter what the scientific evidence done in huge group studies, it is unscientific to stop giving it to the one seizure patient.

Botulinum toxin is one of the most powerful poisons on earth, if not the most powerful, with just the tiniest dose lethal. Should it be banned? Heck no, if the following patients can be helped, and they do not include wrinkle patients.

http://www.webmd.boots.com/a-to-z-guides/botox-medical-uses

How about everyone calming down, and allowing desperate doctors confronting desperate patients to try what they want without obstruction and interference from know nothing, big ninny lawyers making rules that are toxic to our nation, even if based on resolutions by heinous, disgusting medical organizations?

I would even support allowing patients to smoke marijuana if they failed to respond to high doses of marinol.

The reason marijuana should be legalized has nothing to do with medical justifications. It has to do with their effects on the economy and the criminal justice system. The prohibition is in failure, and is contradictory logically to the advertising of legal tobacco and alcohol. You cannot advocate prohibition of marijuana without advocating the prohibition of alcohol, and tobacco, ten times more addictive, and 10,000 times more deadly. Since there is no chance of public support for prohibition of those products, I support the legalization of marijuana for everyone, without prescription. You want only prescribed marijuana? Make alcohol and tobacco by prescription only.

If that's true, then its opposition to legalizing pot is even more telling than I had thought.

Posted by: Bill Otis | Feb 13, 2014 8:56:16 PM

beth --

If the AMA had come out in favor of legalizing pot, rather than being opposed to it, wouldn't your side be shouting that from the rooftops?

Posted by: Bill Otis | Feb 13, 2014 8:58:43 PM

Bill

Boy - I hope I'd look for something better. I might just go with it if I wasn't thinking. Unfortunately, I usually think myself to death before I speak - really wish I didn't.

The thing is, the legal status of marijuana has become untenable to a majority of citizens. I think it's really something that has to be addressed in order to maintain respect for the law. With 800,000 arrests per year for pot - local, state and federal - a huge % of the population has been impacted by it. They also have come to know that lots of productive friends, acquaintances, and family use or have used in the past. It's hard to believe the government marketing message.

I have few fears, but after the amusement is over, drunks can be far more formidable to contend with than pot smokers. That assertion comes from memory - not my present social encounters. Sometimes things just have to be reevaluated.

One of the things I like best about you is that, although you have more reason than most to feel deeply about this issue, you always speak thoughtfully and with moderation.

We just see it differently. I don't think pot figures in the day-to-day thinking of the majority of people. And I think respect for law is most imperiled when those who are supposed to be enforcing it make exceptions and grant waivers and exclusions based on politics or whim, or simply because they have the power to.

Posted by: Bill Otis | Feb 13, 2014 11:10:00 PM

Bill: "left wing" means favoring big government. as in supporting Obamacare, totally opposite of doctors' clinical and economic interests, not to mention a catastrophe for patients.

There is a rebuttable presumption of any AMA resolution being dumbass.

Your best argument is found later in my comment, marinol, ingredient THC from federal owned farm, available to anyone by prescription. Slow absorption makes it hard to use to get high, so one may suspect that advocates of medical marijuana are trying to get high, not to self medicate.

My coming down on the legalization side stems from the logic of allowing allowing alcohol and tobacco, 10 times more addictive, 10,000 times more lethal.

If I may get personal for one moment, something to mull over, because you have a conscience. Prosecutors would lose jobs, budgets, and powers if marijuana were legalized, two ways. One would be a partial retreat from the War on Drugs, worth a $half trillion. The second is indirect. The substitution of marijuana for alcohol in young people would drop other prosecutable crime, since half the murderers, half the murder victims are legally drunk. Think about being a pediatrician specializing in running iron lungs for kids with polio, and the polio vaccine is being proposed for approval. In five years there will be no iron lungs.

Taking a break from all the personal sniping to ask a substantive legal question about federal sentences (shocking, I know).

Marijuana is a Schedule I drug, but it's obviously not punished the same as LSD or Heroin (also Schedule I, iirc). To me, that suggests there are special laws regarding Marijuana punishments. If Marijuana were rescheduled to a Class II or a Class III, would that change the possible punishments one would receive? I'm assuming no changes in the laws itself, it's done purely through reclassification by the FDA (also, leave aside whether the FDA has the authority to make the change unilaterally if you don't mind).

Posted by: Erik M | Feb 14, 2014 11:10:23 AM

Thanks Bill, Yes, sometimes I ache.

Your probably right that pot doesn't figure in the day to day thinking of most people when they're in their comfort zone. My comfort zone has always been golf courses, tennis courts and board meetings. I didn't talk about legalization till I had to, then the most surprising thing happened. There were many confidential discussions about what friends and acquaintances really thought. I realized that so many arrests impacted people you would never expect, thus the 58% of population favoring legalization.

Respect for the law does depend on consistancy in enforcement without waivers and exclusions or simply power. You may see this as the current condition. I don't. To me enforcement and prosecution are not consistant and clear.

If respect for the law depends on a covenent between government and those who are governed you have a more Hobbesian view of human nature than I, requiring a powerful command to govern. Locke comes more to my mind when thinking about governing. It suits me best and thus I believe that respect for the law depends on laws that the majority agree to. That is where I see the issue at this point. That's why it may be a tipping point - I do know we've come a long way from government just protecting rights and freedoms.

Respect for the law? Shouldn't it be effective before earning public respect.

20 million FBI Index felonies. 2 million prosecutions. Incredible murder rates. The government is in utter failure.

So self help, patriarchal family values, religion are each 10 times more effective than lawyer run government. So what does government do? It lays siege to them, from all sides, and seeks to crush them.

Government is a wholly owned subsidiary of the lawyer profession, and looks out solely for its interest. Beyond allowing 9/11, it allows massive criminality, protecting the criminal from eradication.

There will be a reckoning, come the next major terror attack. The hierarchy will be arrested, tried and summarily executed for its betrayal of the constitution.

Did you know that Prof. Berman's major textbook on Sentencing contains no reference to the penalty for treason? I guess he does not want to give people any ideas.

I hope the lawyer can learn from the beginning of the revolution. It will start with a boycott. It will end, where 10,000's of internal traitors are executed, with laws enacted to permanently exclude this traitor profession from all policy positions, especially judgeships, judging being a profession unrelated to lawyering.

Ask your friends about government. Unless they receive a check from government, the verdict will be unanimous.